Individual
T K VENKATESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 N MICHIGAN AVE, #1107, CHICAGO, IL 60602-3402
(312) 236-3642
(312) 236-5162
Mailing address
PO BOX 809094, CHICAGO, IL 60680-9094
(312) 236-3642
(312) 236-5162
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036088143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088143
—
IL
Enumeration date
04/04/2006
Last updated
09/09/2015
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